GROUP PERSONAL ACCIDENT INSURANCE - PRESENTATION - GMS ...

GROUP PERSONAL
ACCIDENT INSURANCE -
   PRESENTATION

Scope of Cover

INSURANCE- SCOPE
GROUP PERSONAL This policy is purely an accident*-instigated policy. It
               covers the financial risk due to death, disability and loss of
               earnings caused due to an accident*. It reduces the
               financial burden on the family as a whole due to loss of
               earning.

                 * Accident - means a sudden, unforeseen, uncontrollable
               and unexpected physical event to the insured person
ACCIDENT-

OF POLICY      caused by external, violent and visible means occurring
               under the circumstances described in a hazard applicable to
               that person.

               Cover is available 24*7, across the world

               Minimum Age : 18 Years
               Maximum Age : 65 Years (Negotiable)

Sum Assured Options:
CATAGORIES OF
SUM ASSURED:
                      Flat (Insurance Cover remains same
                       through out)

                      Graded (Insurance Cover can be in
                       increased in mid term with change in
                       Grade/ Promotions )

                      Multiples of CTC/Basic (Maximum up to
                       10 times of CTC and may vary from
                       insurer to insurer)

                      Combination of the above

     Accidental Death
                 Compensation is payable in case of Accidental Death. In such
                  a loss 100% of the Sum Insured is paid.

                  Dismemberment
                   Compensation is payable if the accident results in the loss of
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                   two limbs or two eyes or one limb &/or one eye.
                   Compensation is also payable if the accident results in loss of
                   speech & loss of hearing in one or both ears. The benefit
                   given depends on the degree of loss.

                  Permanent* Total Disability

                 Compensation is payable if Permanent Total Disablement is
                   caused due to an accident. In such a situation 100% of the
                   Sum Insured is payable.

                 Permanent Total Disability - means total and permanent
                   inability to engage in each and every occupation or
                   employment for compensation or profit for which You are
                   reasonably qualified by education, training or experience for
                   the rest of your life.

                *Permanent - means lasting twelve calendar months and at the
                   expiry of that period being beyond reasonable hope of
                   improvement.

     Permanent* Partial Disablement
                  Compensation is payable in case of partial disablement
                  caused as a result of an accident. In this case the amount
                  payable is based on the degree of disability incurred.

                  Permanent Partial Disability - means the Insured Person
                  has suffered a Permanent loss of physical function or
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                  anatomical loss of use of a body part, substantiated by a
                  diagnosis from a physician.

                Temporary Total Disablement
                A weekly payment of up to 1% of sum insured or Rs. 5,000
                 (negotiable) or as per the actual net weekly salary (whichever
                 is lower) is given for each week up to a maximum of 104
                 weeks.

                Temporary Total Disability - means disability which wholly and
                  continuously prevents such Insured Person from performing
                  each and every duty pertaining to his occupation.

    Accidental Medical Expenses

            Option -1 (Variable)

            Medical expenses incurred in the treatment of an accident covered
                under the policy, subject to a limit of 10% or 25 % of the sum
                insured or 40% of the death / disability compensation claim
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                payable.

            Option -2 (Fixed)

            Medical expenses incurred in the treatment of an accident covered
               under the policy, subject to a flat limit of Rs. 5K to 1 lac
               (negotiable) or actual bills whichever is lower.

            NOTE:
            1. There is no linkage with any other type of claim.
            2. This is not annual limit, each accident has fresh limit.

                Terrorism Cover

                 There is no exclusion of terrorism cover in GPA policy
                 although few private insurers excludes this coverage.

                AOA : AOY limit

Riders :
                  Child Education Benefit
                  In case of Accidental Death or Permanent Total Disablement, claim
                  towards the education support of the deceased person‟s Dependent
                  Child the sum equivalent to 1% of the total sum insured subject to
                  maximum of Rs.10,000 (limit can be negotiated). This benefit shall be
                  limited to the maximum two number of children.
BRIEF ON RIDERS

                  Repatriation Benefit and Funeral Expenses

                  In case of claim for Accidental Death , an expenses incurred for
                  preparing body for burial or cremation and transportation of body to city
                  of residence . Funeral Expenses is also payable. The benefit payable
                  towards shall be limited to 1 % of the Principal Sum Insured subject to
                  maximum of Rs 12,500/- (limit can be negotiated)

                  Hospital Cash Allowance

                  In case for claim of Accidental Bodily Injury, and in the event of the
                  injured person requiring treatment in a Hospital as an inpatient then the
                  payment of the sum of Rs. 1,000/- (limit can be negotiated) for each
                  completed calendar day of Hospitalization for a maximum period of 30
                  days during the Policy Period will be payable.

 Modification/ Adaptation allowance

                    In case of Permanent Total Disablement which resulted from an
BRIEF ON RIDERS     Accident and insured is required to modify his vehicle or make
                    some changes in his house ,insurer will reimburse such expenses
                    up to a limit of 10% of the total Sum Insured subject to a maximum of
                    Rs.50,000 (limit can be negotiable)

                   Family Transportation Allowance

                     In case of an admissible claim for Death, Permanent Total or
                    Permanent Partial Disablement under the Policy, if the Insured
                    Person is confined in a Hospital outside 100 kms of his normal place
                    of residence, within 12 months from the date of Accident, and the
                    attending Medical Practitioner recommends the personal
                    attendance of an immediate family member, insurer will reimburse the
                    expenses incurred for the immediate family member for transportation
                    by the most direct route by a licensed common carrier to the place of
                    confinement of the Insured Person. The maximum amount payable
                    for this cover shall be limited to 10% of the total Sum Insured subject
                    to maximum Rs.50,000/-. (limit can be negotiable)

 Death of Primary Key Member

                     In case of the death of the spouse wherein the spouse is a primary
BRIEF ON RIDERS      earning member of the family (as per IT returns), 10 lacs (limit can be
                     negotiable ) would be payable in case of accidental death of a spouse,
                     with 5 such maximum cases (again number of cases is
                     negotiable )per year.

                   Double Dismemberment

                     In case of dismemberment, the amount payable is in addition (double
                     the % value ) to the amount payable under permanent disability
                     section.

                   Injury or Death Caused during any sports event (duly organized by
                    company ) or during Company outing can also be covered up to
                    policy benefits.

Key points :
              OPD treatment / daycare treatment due to an accident is covered
               if medical expenses is opted.
              Any co-payment or deductible under Mediclaim policy (claim
               reported due to an accident ) can be claimed by submitting the
               original bills of the amount to be claimed and photocopy of the
               rest treating and settled documents.
              In case of fatal accident, ambulance charges of higher amount can
KEY POINTS

               be claimed under Mediclaim section as there is generally no limits
               in GPA policy for ambulance and is covered up to the medical
               expenses amount.
              Murder is considered as an accidental death and claim is payable.
              Vaccinations charges after Dog bite /snake bite is covered.

Exclusions :
             •   Intentional self Injury (including but not limited to the use or misuse
                 of any intoxicating drugs or alcohol)
             •   Accident while under the influence of alcohol or drugs.
             •   Participation in an actual or attempted felony, riot, crime,
                 misdemeanor or civil commotion
             •   Any Accident of which a contributing cause was the Insured
                 Person’s actual or attempted commission of, or willful participation in,
                 an illegal act or any violation or attempted violation of the law or his
EXCLUSIONS

                 resistance to arrest.
             •   Whilst engaging in Aviation or Ballooning or whilst mounting into,
                 dismounting from or traveling in any balloon or aircraft other than as
                 passenger(fare paying or otherwise) in any duly licensed standard
                 type of aircraft.
             •   Participating in motor racing or trial run as a driver, co-driver or
                 passenger
             •   Curative treatments or interventions that the Insured Person carries
                 out or have carried out on his body
             •   Pregnancy and childbirth, miscarriage, abortion or complications
                 arising out of any of these

Exclusions :
             •   War, invasion, acts of foreign enemies, hostilities (whether war be
                 declared or not), civil war, commotion unrest, rebellion, revolution,
                 insurrection, military or usurped power or confiscation or
                 nationalization or requisition of or damage or under the order of any
                 government or public authority
             •   Nuclear energy, radiation
             •   Any existing disablement prior to the inception of the Policy
             •   Venereal or sexually transmitted diseases, HIV (Human
EXCLUSIONS

                 Immunodeficiency Virus) or HIV related Illness including AIDS
                 (Acquired Immune Deficiency Syndrome) and / or mutant derivatives
                 or variations however caused.
             •   Any Medical expenses, services, supplies or treatment or Hospital
                 stay which were not recommended or approved as Medically
                 Necessary by a Medical Practitioner.
             •   Any expense incurred which is not exclusively medical in nature/
                 Unproven or Experimental treatment of any description.
             •   Expenses incurred for emergency medical evacuation
             •   Standard list of excluded items as notified by IRDA attached as
                 annexure 1.

THANK YOU